Basic Information
| Provider Information | |||||||||
| NPI: | 1003903147 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRASE | ||||||||
| FirstName: | TERESA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9880 ANGIES WAY | ||||||||
| Address2: | STE. 400 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402412851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023946500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2006 | ||||||||
| LastUpdateDate: | 01/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 43780 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD39365 | TN | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.